Provider Demographics
NPI:1689635104
Name:HAZOURI, GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:HAZOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5509
Mailing Address - Country:US
Mailing Address - Phone:352-373-4300
Mailing Address - Fax:352-372-1641
Practice Address - Street 1:708 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-373-4300
Practice Address - Fax:352-372-1641
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13279207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL209027OtherAVMED HEALTH PLAN
FL049691000Medicaid
FL01884OtherBLUE CROSS BLUE SHIELD FL
FL049691000Medicaid
FL01884OtherBLUE CROSS BLUE SHIELD FL
FL180032446Medicare PIN